As US COVID-19 cases surge, public health officials are battling broken, fragmented data systems, some relying on fax, that are seriously impeding progress
Before public health officials can manage the pandemic, they must deal with a broken data system that sends incomplete results in formats they can't easily use. Tweets: @sarahkliff , @bymikebaker , @lolgop , @yfreemark , @dylanbgeorge , @sam_baker , @nytimes , @ryanlcooper , @elidourado , @sangerkatz , @jennifernuzzo , and @amymaxmen Tweets: Sarah Kliff / @sarahkliff : Good morning, this is how coronavirus test results are transferred and tracked in 2020. https://www.nytimes.com/... https://twitter.com/... Mike Baker / @bymikebaker : An office leading coronavirus efforts in Austin, Texas, is receiving around 1,000 faxes a day. In Washington State, 25 National Guard members are helping with manual data entry. “The data is moving slower than the disease.” https://www.nytimes.com/... @lolgop : Of Trump's crimes, the one that's resulted in the most death and economic misery is his refuse emergency powers to set up a national testing program. https://twitter.com/... Yonah Freemark / @yfreemark : How.... in this lovely year 2020.... are public health departments still relying on fax machines? https://twitter.com/... Dylan George / @dylanbgeorge : Data systems in the U.S. need modernization so we can move public health interventions at the speed of the pandemic; not the speed of shuffling papers in a bureaucracy. @cmyeaton @nataliexdean https://twitter.com/... Sam Baker / @sam_baker : “Washington State recently brought in 25 members of the National Guard to assist with manual data entry” https://www.nytimes.com/... @nytimes : Public health officials in Houston are struggling to keep up with one of the nation's largest coronavirus outbreaks. But first, they must negotiate with an overworked fax machine. https://www.nytimes.com/... Ryan Cooper / @ryanlcooper : American health care may cost 18 percent of GDP, but at least we've got plenty extra to spend on cutting-edge communication https://twitter.com/... Eli Dourado / @elidourado : In the middle of a pandemic is probably not the right time to do it, but banning fax machines would probably be net-positive for the world. https://www.nytimes.com/... Margot Sanger-Katz / @sangerkatz : In Houston, the fax is so overwhelmed that it is spitting pages all over the floor. In Philadelphia, a team is looking up phone numbers on Lexis Nexis. In Washington, the governor called in the National Guard...to do manual data entry. https://www.nytimes.com/... Jennifer Nuzzo / @jennifernuzzo : When I was a practitioner epidemiologist, I used to get grainy fax reports of surveillance data. It is a national embarrassment that this practice still exists 20 years later. #retirethefax #upgradepublichealth https://twitter.com/... Amy Maxmen / @amymaxmen : About 80% of coronavirus test results in the US are missing basic demographic information, nevermind info on exposures. If I were reporting on an outbreak response in Congo or Liberia, the CDC & US epidemiologists would be wagging their fingers. For shame! https://www.nytimes.com/...
Context & Ripple Effects
The US has been running pandemic surveillance through the same syndromic-surveillance architecture built after the early-2000s outbreaks, with aggregated hospital data flowing into federal databases hosted on AWS — a system designed for trend-spotting, not case-level management at surge scale. That legacy is now colliding with a testing volume it was never shaped for.
This isn't a failure of investment but of integration: the country already spent $36B digitizing health records, yet much of that spend produced software whose glitches and closed formats left health departments receiving test results by fax. The gap between official numbers and reality got visible when a volunteer-run site, the Covid Tracking Project, became one of the most trusted sources on spread — an implicit verdict on government pipelines.
First-order effects
- Washington State deployed 25 National Guard members to hand-enter coronavirus test results, and an Austin, Texas office leading local response is stuck with incomplete feeds — with roughly 80% of US test results missing basic demographic information, officials cannot tell who is being infected or direct resources accordingly.
Second-order effects
- Volunteer operations like the Covid Tracking Project absorb demand the states can't meet, shifting de facto authority over pandemic numbers to non-governmental actors and forcing federal agencies to reconcile their counts against outside datasets.
- Health IT vendors face renewed scrutiny: after $36B of records digitization yielded fax-era handoffs and safety incidents, procurement pressure builds toward interoperable, machine-readable reporting contracts rather than proprietary formats.
Third-order effects
- If the pattern holds, pandemic response drives a structural rebuild of public-health infrastructure around standardized digital case reporting, with Congress and the CDC treating data plumbing as core emergency capacity rather than back-office overhead.
- A durable two-track information ecosystem risks emerging where trusted national statistics come from volunteers and universities while official systems lag — eroding institutional credibility long after this outbreak.
The trend: Public-health surveillance is being forced from paper-era transmission toward real-time machine-readable pipelines, with volunteer data projects temporarily outpacing the state they are trying to help.